“Ten-year overall survival for primary breast cancer patients treated with sentinel lymph node dissection (SLND) alone is similar to that seen in those treated with axillary lymph node dissection (ALND), according to a study published in the Sept. 12 issue of the Journal of the American Medical Association.

“The American Society of Clinical Oncology’s (ASCO’s) new recommendation that that some women with early-stage breast cancer and minimal lymph node involvement can forgo extensive lymph node surgery has been questioned separately by two sets of clinicians.

“The guidelines were originally published in May 1 in the Journal of Clinical Oncology (JCO), the flagship journal of ASCO.

“Now, in letters to the journal published on September 22, critics are saying that there is not enough evidence to support the recommendation.

“But the investigators of the trial on which the recommendation is based argue back, saying it is time to skip the surgery in certain patients.”

“Individualized education and counseling should begin before surgery and continue throughout treatment for breast cancer survivors fearful of developing lymphedema, especially younger patients and those at higher risk after axillary lymph node dissection (ALND), a recent study found.

“More than 300 patients undergoing treatment for unilateral breast cancer were screened for lymphedema before and every 3 to 8 months after surgery and asked to fill out questionnaires assessing their fear. Higher preoperative fear score, age younger than 50 at diagnosis, and ALND were significantly associated with higher mean postoperative fear scores. The findings were published in the September issue of Oncology Nursing Forum.

“ ‘If and when fear of lymphedema is identified, nurses should evaluate whether that fear generates appropriate proactive behavior to prevent lymphedema or whether it negatively affects the survivor’s physical or mental state,’ the authors wrote. ‘In the latter case, such fear should alert nurses to counsel, educate, reassure, support, and reassess the patient on an ongoing basis.’

“The findings indicate that lymphedema—characterized by abnormal accumulation of fluid in the interstitial spaces of the arm, hand, shoulder, breast, or chest wall—is distressing to many women regardless of whether or not they develop the condition, the authors said. In addition to physical symptoms such as swelling, heaviness and discomfort, and an increased risk of infection, many women experience psychological distress leading to poor body image, lower self-esteem, and increased anxiety.”